Risk factors, management and outcomes of patients admitted with near fatal asthma to a tertiary care hospital in Riyadh

Near-fatal asthma [NFA] has not been well studied in Saudi Arabia. We evaluated NFA risk factors in asthmatics admitted to a tertiary-care hospital and described NFA management and outcomes. This was a retrospective study of NFA patients admitted to an ICU in Riyadh [2006-2010]. NFA was defined as a severe asthma attack requiring intubation. To evaluate NFA risk factors, randomly selected patients admitted to the ward for asthma exacerbation were used as controls. Collected data included demographics, information on prior asthma control and various NFA treatments and outcomes. Thirty NFA cases were admitted to the ICU in the five-year period. Compared to controls [N= 120], NFA patients were younger [37.5 +/- 19.9 vs. 50.3 +/- 23.1 years, P= 0.004] and predominantly males [70.0% vs. 41.7%, P= 0.005] and used less inhaled steroids/long-acting 32-agonists combination [13.6% vs. 38.7% P = 0.024. Most [73.3%] NFA cases presented in the cool months [October-March]. On multivariate analysis, age [odds ratio [OR] 0.96; 95% confidence interval [Cl], 0.92-0.99, P= 0.015] and the number of ED visits in the preceding year [OR, 1.25; 95% Cl, 1.00-1.55] were associated with NFA. Rescue NFA management included ketamine [50%] and theophylline [19%] infusions. NFA outcomes included: neuromyopathy [23%], mechanical ventilation duration = 6.4 +/-4.7 days, tracheostomy [13%] and mortality [0%]. Neuromuscular blockade duration was associated with neuromyopathy [OR, 3.16 per one day increment; 95% Cl, 1.27-7.83]. In our study, NFA risk factors were younger age and higher number of ED visits. NFA had significant morbidity. Reducing neuromuscular blockade duration during ventilator management may decrease neuromyopathy risk

Home intravenous antibiotics in a tertiary care hospital in Saudi Arabia

Home intravenous [IV] antibiotic programs are becoming increasingly popular worldwide because of their efficacy and safety. However, in Saudi Arabia these programs have not yet become an integrated part of the health care system. We present our experience with a home IV antibiotic program, as one of the major health care providers in Saudi Arabia. Retrospective chart review of patients enrolled in the King Abdulaziz Medical City Home Health Care IV Antibiotic Program from 1 May 2005 [the start of the program] until 30 December 2007. In addition to demographic characteristics, we collected data on the site of infection, the clinical diagnosis, the isolated microorganisms, and the type of antibiotics given. Outcome measures evaluated included the relapse rate, failure rate, the safety of the program, and readmission rates. Of the 1 55 patients enrolled, 1 52 patients completed the program. Those who completed the program had a mean [SD] age of 52.8 [23.9] years. The mean [SD] duration of the IV antibiotic treatment was 20.6 [17] days. Three patients refused to complete the intended duration of therapy. Peripherally inserted central catheter [PICC] lines were utilized in 130 patients [86%]. One-hundred and thirty-one patients completed the intended duration of therapy, although the therapy was changed from the initial plan for 21 [13.8%] patients. Readmission to the hospital during therapy was required for 13 patients [8.5%]. Osteomyelitis was the most frequently encountered diagnosis [65 patients, 42.8%], followed by urinary tract infection [36 patients, 23.7%]. The home health care-based IV antibiotic program was an effective and safe alternative for in-patient management of patients with non-life-threatening infections, and was associated with a very low complication rate. Home IV antibiotic programs should be used more frequently as part of the health care system in Saudi Arabia